State social services workers signed up homeless residents for Medicaid at a resource fair in Richmond in 2018. Enrollment in the program has more than doubled since Medicaid expansion, leading to rising demand for mental health services. (Photo by Ned Oliver/Virginia Mercury)
With the threat of federal budget cuts looming, Virginia lawmakers are laying the groundwork to respond to potential changes that could impact healthcare coverage for roughly 630,000 residents.
As the General Assembly prepares for budget negotiations with Gov. Glenn Youngkin, proposed amendments include contingency plans to address possible federal reductions to Medicaid funding. Sen. Creigh Deeds, D-Charlottesville, emphasized the need for readiness.
“There are variations of what can come from Washington,” Deeds said. “We have to be prepared to respond and that’s what the budget language allows.”
Medicaid, a joint federal-state program, provides health coverage to low-income individuals and people with disabilities. Since Virginia expanded its Medicaid program in 2018, the federal government has covered 90% of the costs for newly eligible enrollees, while the remaining 10% has been funded by the state’s private acute-care hospitals.
However, Virginia’s Medicaid expansion included a “trigger” provision, meaning that if federal funding levels were altered, the state could be forced to scale back or eliminate coverage for those who rely on it.
With Congress still sorting through its spending priorities, Virginia lawmakers want a plan in place should those funds be reduced.
The Senate’s budget proposal includes an amendment that would direct a joint subcommittee focused on health policy to convene if federal cuts occur. While this amendment does not remove the existing trigger language, it gives lawmakers a chance to assess the financial impact and explore options before Medicaid enrollees automatically lose coverage.
Freddy Mejia, policy director at The Commonwealth Institute, called the amendment an important safeguard.
“I think it’s a step in the right direction in terms of trying to create a timeline where (addressing cuts) doesn’t start with the automatic coverage loss of people,” Mejia said.
As Republicans in Congress push proposals to reshape Medicaid — including capping federal payments to states based on population and imposing work requirements — Virginia officials and healthcare providers are watching closely for what comes next. With the GOP controlling both the House and the U.S. Senate, any legislation that passes could find a willing signatory in President Donald Trump.
Though Trump was silent on Medicaid during his campaign, a recent White House memo freezing federal funding singled out Medicare and Social Security as protected — while leaving Medicaid’s fate uncertain.
Virginia’s private hospitals, which have financially supported the state’s Medicaid expansion since 2018, are closely monitoring federal developments.
Julian Walker, a spokesperson for the Virginia Hospitals and Healthcare Association, said hospitals have been “proud” to help sustain the program, but acknowledged uncertainty about what lies ahead.
“At this point, while there is plenty of conjecture about what may or may not happen on the federal level, it remains to be seen what actions the White House and Congress may take in that regard,” Walker said.
Cuts to Medicaid could also disproportionately affect Virginia’s rural areas — a recent report from Georgetown University notes how adults and children in rural areas are more likely to rely on the program for their health insurance. Though expanding the program in 2018 was led by Democrats, Republicans from rural parts of Virginia backed the idea.
“We’ve got to stay nimble, flexible and financially solvent,” said Del. Rob Bloom, R-Accomack, who co-chairs a new special committee the House of Delegates that will explore actions the state can take if a wide range of federal funding or job cuts occur that affect Virginia.
With the healthcare coverage of thousands of Virginians hanging in the balance, U.S. Sen. Tim Kaine, D-Va, is pledging to push back against any efforts to shrink Medicaid.
“I will strongly oppose any proposal to take away healthcare from Virginians,” Kaine told The Mercury.
During a meeting with nonprofit leaders in Richmond on Monday, Kaine said his office has been “flooded” with questions about federal funding, including Medicaid, as Trump’s administration and congressional Republicans focus on potential corporate tax cuts.
He likened the months ahead to assembling a jigsaw puzzle as he works to advocate for Virginians.
Constituents “give me the ability to turn over a piece of the jigsaw puzzle so that I can assemble it, so that I can advocate better,” Kaine said.
As Congress moves forward with budget discussions, the future of Medicaid — and the 630,000 Virginians who rely on it — remains uncertain.
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